The researchers say that the data clearly support the existence of a cohort who had clear autism at a young age and no longer demonstrated any significant autistic impairments.

The possible presence of subtle limitations or differences in social behavior, social cognition, communication, or executive functions remain to be elucidated in further analyses, as do many other crucial questions, such as the biology of remediable autism, the course of improvement, and the necessary and sufficient conditions, including treatment, for such improvement.

This research challenges the common belief that autism spectrum disorders are inevitably life-long.

To understand research like this, people need to appreciate fully the meaning of phrases like "significant autistic impairments". "Autism" in the clinical sense means "severe and pervasive impairment"; "autism" does not mean all the differences that a person with an ASD diagnosis may have from some perception of "normal". treatment/remediation for autism, that may result in an optimal outcome, relates to clinical level autistic impairment. Appropriate treatment/remediation for autism is not about changing a person's "difference" or trying to make someone "normal".

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IT IS possible for a small number of children diagnosed early with autism spectrum disorder (ASD) to later move off the spectrum, research suggests.

US researchers tested 34 children with a history of ASD who no longer carried the diagnosis and were described as having an ‘optimal outcome’.

They also assessed 34 typically developing peers and 44 children with ‘high-functioning’ autism. They ranged in age from eight to 21-years-old and were matched based on age, gender and non-verbal IQ.

After cognitive testing and parent interviews, the authors found those in the optimal outcome group had a clear, documented history of ASD, yet no longer met the criteria based on the Autism Diagnostic Observation Schedule (ADOS) and clinical judgement.

They demonstrated normal language, face recognition, communication and social interaction.

Their diagnoses, which occurred before age 5, were verified by a co-investigator blinded to the outcome.

After examining their histories, the authors said these children had milder social deficits than the high-functioning group in early childhood. However, there was no difference in their communication ability or repetitive behaviours.

The group also had mean IQs in the high average range. The authors said above average cognition may have allowed some to compensate for their deficits.

“The results clearly demonstrate the existence of a group of individuals with an early history of ASD, who no longer meet criteria for any ASD, and whose communication and socialisation skills ... are on par with that of typically developing individuals matched for IQ, sex, and age,” they said.

They added the results did not necessarily mean subtle residual deficits did not remain, such as anxiety or depression.

Olga Tennison Autism Research Centre at La Trobe University director Associate Professor Cheryl Dissanayake said each year at her clinic a handful of children moved off the spectrum.

In an ongoing study being conducted in Victoria, 14% of children assessed as having autism at 24 months, no longer met the criteria at 48 months.

Professor Dissanayake’s team is now looking at what predicts those children’s movement off the spectrum.

Initial analysis suggests the children who moved off the spectrum had better receptive language at 24 months. They were also better at integrating their gaze with other behaviours, made more frequent focalisations to others and had lower scores for unusual eye contact.

Professor Dissanayake emphasised only a small number of children go on to no longer meet the criteria for ASD.

“If children are identified early and receive good evidence-based behavioural treatments at a high intensity, outcomes are possible. Even if children don’t leave the spectrum they can make incredible gains,” she said.

... challenging the established view that it is a permanent, incurable condition

Identifying transition from 'autistic' to functioning like their peers could lead to effective therapies

Jeremy Laurance

Some children diagnosed with autism at a young age later grow out of it, psychologists say, in a discovery that challenges the established view of condition as a permanent disorder of social functioning with no cure.

If the finding is confirmed, identifying what helped those children who have made the transition from “autistic” to functioning like their peers could point the way to effective therapies, they say.

An estimated 600,000 people in Britain are affected by autistic spectrum disorders, which alter their capacity to interact with others. Sufferers have difficulty reading social situations and responding appropriately and may lead lonely and isolated lives as a result.

The condition ranges from the mild to the severe, but half of those affected are undiagnosed. Autism, it has long been thought, is a lifelong and incurable condition, although sufferers can be helped to learn to cope with the condition.

Now researchers funded by the US National Institutes of Health say that view may have to be reassessed. The researchers identified 34 children and young adults ranging in age from eight to 21 who were considered to be on a par with their peers but had earlier been diagnosed with an autistic spectrum disorder.

In each case, the researchers carefully documented the earlier diagnosis and got experts to cross check it. They then compared the children today with a second group, matched for age and sex, who had been diagnosed with “high functioning“ autism – showing expert skills such as in drawing or mathematics – and with a third group of children whose development was unaffected.

Thomas Insel, director of NIMH, said: “Although the diagnosis of autism is not usually lost over time, the findings suggest that there is a very wide range of possible outcomes. Subsequent reports from this study should tell us more about the nature of autism and the role of therapy and other factors in the long term outcome for these children.”

The children are now being studied further to see if there have been changes in brain function or whether they still have subtle social deficits. The types of therapy they received are also being reviewed and their role in the transition assessed.

The researchers note that the children who appeared to have grown out of autism had a relatively mild form of the condition and a slightly higher IQ than those with high functioning autism. As people with autistic spectrum disorders have to learn social behaviour that comes instinctively to others, such as looking people in the eye when talking to them, it is possible that having a higher IQ may help in acquiring these “normal” traits.

Deborah Fein of the University of Connecticut, who led the study published in the Journal of Child Psychology and Psychiatry, said: “All children with autistic spectrum disorders are capable of making progress with intensive therapy, but with our current state of knowledge most do not achieve the kind of optimal outcome that we are studying. Our hope is that further research will help us better understand the mechanisms of change so that each child can have the best possible life.”

“This study is looking at a small sample of high functioning people with autism and we would urge people not to jump to conclusions about the nature and complexity of autism, as well its longevity.

“With intensive therapy and support, it’s possible for a small sub group of high functioning individuals with autism to learn coping behaviours and strategies which would ‘mask’ their underlying condition and change their scoring in the diagnostic tests used to determine their condition in this research.

“This research acknowledges that a diagnosis of autism is not usually lost over time and it is important to recognise the support that people with autism need in order to live the lives of their choosing.